Mental Health/Psychiatry

Question 1

1. Scenario of alcohol withdrawal symptom which will be accompanied
   A. Crawling of insects on wall
   B. Auditory hallucination
   C. Sweeting
   D. Metallic taste in mouth

Answer 1

A. Crawling insects on wall.

Delirium Tremens - Clinical features:
* Precipitated by intercurrent infection or trauma/surgery
* 1 - 5 days after withdrawal (usually 3 - 4 days)
* Disorientation, agitation
* Clouding of conciousnes
* Marked tremor
* Visual hallucinations (e.g: spiders, pink elephants)
* Sweating, tachycardia, pyrexia
* Signs of dehydration

Treatment:
* hospitalisation with alcohol specilaist advisory service
* Correct fluid & electrolyte imbalance with IV therapy
* Treat systemic infection
* Thiamin (B1) 300 mg IM or IV daily
* Diazepam (20mg) every 2 hours up to 100mg daily until symptoms subside. Usually required for 2 - 3 days, then reduced until finiished.
* If psychotic features present (hallucinations, delusions) add haloperidol b.d titrated to clinical response.
* Chlorpromazine is not recommended due to ability to decrease seizure threshold. Always be aware that diazepam & haloperidol can increase hepatotoxicity.